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Health Inequalities

10-03-2004 (updated: 26-10-2007 )

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With the eastern enlargement of the EU, more attention is being drawn to the fact that the citizens of the less wealthy Central and Eastern European countries have poorer health and shorter life expectancy than those in Western Europe. In addition to the east-west gap in health, differences in health between socioeconomic groups have increased in many countries as socio-economic determinants such as education, employment and life-style affect the health.

Background

The most important issues that the EU will need to tackle concerning (unequal) access to health is the widening of the "health gap". Most European countries have identified links between inequality and disadvantage and their damage to health. National reports have highlighted the fact that, although health has improved on average over the past 50 years, in recent decades health inequalities have remained static or widened. A study by the INSERM (Institut national de la santé de la recherche mécale) found that mortality in France among blue-collar workers aged 45-59 years is 71% higher than among their white-collar peers. 

Another issue that is sometimes brought up in the context of "health inequalities" is the delayed availability of innovative drugs in some member states - even though they are already available in other states. The main cause of this problem is the difference between authorisation procedures in different Member States. Sometimes, governments have an interest in delaying the entrance of new drugs on the market, in order to cut down public health costs.

The European Commission has launched a series of projects aimed at addressing the health gaps between genders and socioeconomic groups. It highlights the need to improve services for disadvantaged citizens and reduce inequalities within and between member states. A progress report will be presented in 2012. 

Infant mortality ranges from around three per 1000 live births to more than 10 per 1000, according to Eurostat. The Commisiosn highlighted the fact that people with a lower level of education and lower income, tend to die at a younger age and have a higher prevalence of most types of health problems. 

Many of these differences are due to social and environmental factors, as well as avoidable behaviours such as smoking, drinking and diet. 

 

Issues

What can be done to narrow the health gap? Several policy options are available: 

  • Reducing economic and social inequalities: Poverty and poor health can turn into a true vicious cycle from birth to death. Children born into disadvantaged families tend to have a lower birth weight due to harmful influences during pregnancy and are more likely to incur accidents. Underprivileged people are also at higher risk of chronic stress and repeatedly disappointed professional and private expectations not only cause long-term disease, but can also push people towards substance abuse. The disadvantaged thus tend to be more frequently subjected to fatal illnesses (cancer, strokes and heart failure) and their chance of surviving these tend to be lower. Therefore it appears that, besides publicly-funded health and education services, the reduction of economic and social inequalities is the key to reducing health inequalities.  
  • Redistributive tax policy: Research indicates that even a minor shift in wealth could prevent numerous premature deaths. The reintroduction of a redistributive tax policy could therefore play a role in preventing premature death. Nevertheless, reality shows that redistribution of income in Europe is currently moving in the opposite direction, as relative poverty continues to rise with incomes of top executives rising sharply.
  • Social transfer payments: Countries that are most successful at reducing inequality and poverty are those that spend the largest amounts on social transfer payments, such as rent rebates and child allowances, and other than pensions, as they help reduce poverty.
  • Reform of the Common Agricultural Policy: According to the WHO, 14% of all deaths in the European region are caused by a poor or unhealthy diet (called "food inequity"). Some NGOs have therefore called for a reform of the CAP so that its main objective would be safe and healthy food as a human right, which could be achieved, for example, by increasing financial support to healthy consumption and production (e.g. increased availability of fruits and vegetables).
  • Reducing homelessness and housing improvements: A study by rese archers at the London School of Hygiene and Tropical Medicine shows that the lives of several hundred people in the UK each year could probably be saved by improvements in the insulation and heating of their homes.
  • Supporting health promotion activities: Health promotion is "the process of enabling people to exert control over the determinants of health and thereby improve their health." Traditional approaches to health promotion, such as providing health information, fail to reduce health inequalities effectively because they tend to benefit the wealthy more than the poor. The European Commission has therefore developed a wider vision of how to use health promotion to reduce health inequalities in Europe. Measures proposed include developing national health inequality targets, working at the local level, reducing barriers in access to health services, and integrating health determinants into other policy areas.
  • Integrating health determinants into other policy areas: The health sector in itself can only achieve limited results in reducing health inequalities. However, by integrating health determinants into fiscal, education, agriculture and housing policy, a great deal could be done to narrow the "health gap".

The management of health systems is an exclusive competence of the member states. Nevertheless, the EU has been taking iniatives to encourage the improvement of health standards in the EU.

Positions

According to the World Health Organisation, it is particularly important to help children to avoid ill health and to become resilient enough to remain in good health long into old age, as most countries have declining birth rates and growing elderly populations.

Head of EU policy at the European Cancer Patient Coalition, Hildrun Sundseth: "Many cancer deaths could be avoided each year if best practice in early detection through cancer screening were applied systematically". It is estimated that annually 25,000 women's lives could be saved, if screening for breast cancer according to European quality guidelines were available throughout the EU. 

A European Institute of Women's Health report on women's health in Europe highlights substantial differences in women’s health status, exposure to health risks and access to healthcare across Europe. "Addressing these health inequalities through health promotion, disease prevention and multi-sectoral actions should be at the heart of public health policy both at national and European Union levels", commented MEP Irena Belohorska. 

The International Longevity Centre-UK thinks that age needs to be considered as part of the health inequalities policy debate and points to the fact that health promotion and public health campaigns tend to focus on changing behaviours only in younger people. It states that "prevention is for older people too" and lists a healthy diet, non-smoking, physical exercise and moderate alcohol use as the main factors of healthy ageing.

Timeline

Further Reading

EU official documents

International Organisations

Governments

Business & Industry

NGOs and Think-Tanks

Think tanks & Academia

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